MEDICARE: CLYDE FRALEY LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	203587	TX

General Provider Information

NPI Number	:	1528829637
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLYDE FRALEY LMFT

Provider Business Mailing Address
First Line	:	320 RIVUS OVERLOOK DR
Second Line	:
City	:	WILLIS
State	:	TX
Zip	:	77318-1212
Country	:	US
Telephone Number	:	936-217-4264
Fax Number	:

Provider Business Practice Location Address
First Line	:	1110 N LOOP 336 W STE 430A
Second Line	:
City	:	CONROE
State	:	TX
Zip	:	77301-1193
Country	:	US
Telephone Number	:	936-217-4264
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/17/2024
Last Update Date	:	02/09/2026

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